Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. https://www.selleckchem.com/products/h-cys-trt-oh.html In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre- and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.Over the past 40 years, the technological and surgical advancements in penile prostheses have led to increased patient satisfaction rates and decreased complication and infection rates. In cis males with erectile dysfunction (ED), these technological improvements tremendously improve quality of life. In female to male transgender patients, prostheses provide the ability to engage in penetrative intercourse and to urinate standing. This review evaluates technological and surgical advancements in penile prosthetics in the context of documented patient satisfaction and complication rates from prosthesis surgeries. Retrospective studies of penile implant usage in female to male gender-affirming surgeries report that infection and complication rates are higher than those seen in cis males. There are newer prostheses developed specifically for female to male reassignment surgeries, but outcome data is limited. Continued research and development are needed to develop more efficacious penile implantation options for gender affirmation surgery.Erectile dysfunction (ED) impacts a significant portion of the aging male population. Standard treatments such as oral medications, intracavernosal injections, intraurethral suppositories, vacuum erection aids, and penile prosthesis placement have stood the test of time. Recently, there has been a growing interest in the concept of regenerative medicine with the goal of restoring or renewing functional tissue. Low intensity shock wave therapy (LiSWT) is one example of a regenerative therapy. A strong body of basic science data suggests that shockwaves, when applied to local tissue, will encourage blood vessel and nerve regeneration. Clinical evidence supports the use of LiSWT to treat conditions ranging from ischemic heart disease, musculoskeletal injuries, and even chronic non-healing wounds. LiSWT is also being used to treat male sexual dysfunction conditions such as Peyronie's Disease and ED. The first studied application of LiSWT for ED was published in 2010. Since then multiple randomized, sham-controlled trials have sought to evaluate outcomes for this novel therapy in men with vasculogenic ED. Additionally, several meta-analyses are available with pooled data suggesting that LiSWT results in a significantly greater improvement in erectile function relative to sham-control. Despite these promising findings, the current body of literature is marred by significant heterogeneity relating to treatment protocols, patient populations, and follow-up duration. Further work is necessary to determine optimal device technologies, patient characteristics, and treatment duration prior to considering LiSWT as standard of care for men with ED.Distal urethral strictures can be a challenging entity for urologists. Endoscopic maneuvers such as optical internal urethrotomies or dilations are even less successful than in other urethral locations and the repeated trauma will increase the scarring which advocates for a urethroplasty as primary option for patient management. Success rates of distal urethroplasties have been lower than those for other urethral strictures due to the anatomy of the distal urethra with a very thin corpus spongiosum associated with decreased mucosal blood supply. Also, the high prevalence of lichen sclerosus in this population with circumferential scarring is often a complicating factor. However, in the past two decades several surgical techniques have been described and further developed which has led to significant improvement in stricture recurrence rates. Meatoplasties are indicated for strictures limited to the meatus and involve opening of the stenotic meatus with subsequent reconstruction of it to minimize spraying of urine. Often, however, distal urethral strictures involve the fossa navicularis and may even extend further proximally. These strictures can be addressed with dorsal or ventral inlay procedures using buccal mucosa graft. In addition or alternatively, skin flaps can be mobilized to increase the urethral diameter. Lastly, multi-stage urethroplasty with buccal mucosa are a very successful approach yet given the high success rates of above mentioned procedures are usually reserved for revision surgery or most severe distal urethral strictures. In the following report, we are describing a variety of surgical techniques and their indication which should allow the practicing urologist to successfully address all encountered distal urethral strictures.Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).